Postpartum Hemorrhage

Question 1

Define postpartum hemorrhage x3

Answer 1

Blood loss >= 500ml within 2hrs of vaginal delivery
Blood loss >= 1000ml within 24hrs of C-section
Any blood loss that affect maternal hemodynamic status

Question 2

Define maternal mortality rate

Answer 2

The number of maternal deaths in a given period per population of women who are of reproductive age

Question 3

Maternal mortality ratio

Answer 3

Number of maternal deaths per live births

Question 4

Differentiate between primary and secondary PPH

Answer 4

Primary- within 24 hours
Secondary- from 24 hours up to 6 weeks

Question 5

Uterus factors that control bleeding x3

Answer 5

Spiral arrangement of arteries
Hypercoagulable state
Increased prostaglandins

Question 6

What are the 4 Ts of primary PPH

Answer 6

Trauma- genital tract
Tone- uterine atony
Tissue- retained products of conception
Thrombin- coagulopathy

Question 7

Causes of secondary PPH

Answer 7

Uterine infection endometritis

Question 8

Risk factors for uterine atony x5

Answer 8

Multiparity
Chorioamnionitis
Prolonged labor
Over distension of uterus
Labour induction or augmentation

Question 9

Risk factors for trauma in PPH x5

Answer 9

1. Forceps delivery
2. Vigorous labor
3. Episiotomy/laceration
4. Removal or retained placenta
5. Extra/intrauterine manipulation of fetus

Question 10

Disorders of coagulation x4

Answer 10

HELLP
Von Willebrand disease
Dilutional coagulopathy
Idiopathic thrombocytopenic purpura

Question 11

Clinical presentation of PPH x3

Answer 11

Heavy bleeding
Signs of shock
Enlarged uterus

Question 12

Describe steps of AMTSL ie active management of third stage of labor in PPH prevention x5

Answer 12

Oxytocin 10IU after delivery
Controlled cord traction
Uterine massage
Regular and frequent assessment of uterine tone
Misoprostol

Question 13

Initial steps on how to stop bleeding in PPH x2

Answer 13

Bimanual compression
Aortic compression

Question 14

Management of PPH x6

Answer 14

Stop bleeding
Do ABC
IV fluids
Oxygen
Blood samples
Uterine massage

Question 15

Management of uterine atony x5

Answer 15

Vigorous massage
Oxytocin 40IU in 1L IV
Misoprostol 800mcg sublingual
Tranexamic acid 1g IV stat
Examination under anesthesia

Question 16

Surgical management of uterine atony x3

Answer 16

B lynch suture
Bilateral uterine artery ligation
Hysterectomy

Question 17

Medication given when manually removing placenta x2

Answer 17

Pethidine 100mg IM
Ampicillin

Question 18

Management of coagulopathy x4

Answer 18

Packed RBC
FFP
Platelets
Whole blood

Question 19

Degrees of uterine inversion x4

Answer 19

1- inverted fundus up to cervix
2- inverted uterus body up to vulva
3- prolapse of inverted uterus out of vulva
4 - prolapse of inverted uterus and vagina out of vulva

Question 20

When to suspect uterine inversion on bimanual examination x2

Answer 20

Uterine corpus not felt
Firm mass below or near the cervix

Question 21

Immediate complication of PPH x5

Answer 21

Anemia
Hypovolemic shock
Acute renal failure
Acute liver failure
Acute pulmonary edema

Question 22

Obstetric cause of DIC x4

Answer 22

Placenta abruption
HELLP syndrome
Fetal death
Amniotic fluid embolism

Question 23

Risk factor of uterine inversion x5

Answer 23

Fundal placenta
Short umbilical cord
Excessive traction
Abnormal placentation
Previous uterine inversion

Question 24

Define Sheehan’s syndrome and what causes it

Answer 24

Postpartum hypopituitarism secondary to necrosis caused by drop in blood pressure in PPH

Question 25

Complications/presentation of Sheehan’s syndrome x4

Answer 25

Agalactorrhea- cant breastfeed
Unable to resume regular menses
Hypothyroidism
Adrenal insufficiency

Question 26

Types of uterine relaxants x4

Answer 26

MgSO4
Terbutaline
Nitroglycerin
Halogenated general anesthetics

Question 27

Two procedures for uterine inversion

Answer 27

Huntington
Haultain